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Logo of neurologyNeurologyAmerican Academy of Neurology
Neurology. 2016 March 22; 86(12): e132–e133.
PMCID: PMC4820128

Teaching NeuroImages: Severe vasospasm in traumatic brain injury

A 45-year-old man had a severe traumatic brain injury (TBI) with multicompartmental hemorrhages (figure 1). He was initially noted to be awake and following commands with his right side. Two weeks later, his examination deteriorated to coma with flaccid quadriplegia. Initial workup, including EEG, was unrevealing. MRI brain showed new multiterritorial infarcts (figure 1); a catheter-based angiogram confirmed severe vasospasm in several large vessels (figure 2).

Figure 1
CT head and MRI brain
Figure 2
Cerebral angiogram

Vasospasm following TBI has been previously described as underrecognized because it is often clinically silent, and typically occurring in the first several days when symptomatic.1,2 Late and extreme cases, as above, are rarely described.

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Dr. Reznik: study design, analysis/interpretation of the data, drafting/revising the manuscript. Dr. Saeed: analysis/interpretation of the data, revising the manuscript. Dr. Shutter: study design, analysis/interpretation of the data.


No targeted funding reported.


The authors report no disclosures relevant to the manuscript. Go to for full disclosures.


1. Oertel M, Boscardin WJ, Obrist WD, et al. Posttraumatic vasospasm: the epidemiology, severity, and time course of an underestimated phenomenon: a prospective study performed in 299 patients. J Neurosurg 2005;103:812–824. [PubMed]
2. Kramer DR, Winer JL, Pease BA, Amar AP, Mack WJ. Cerebral vasospasm in traumatic brain injury. Neurol Res Int 2013;2013:415813. [PMC free article] [PubMed]

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